Airway, Respiration & Ventilation Flashcards
The backward, upward, and rightward pressure used during intubation to improve the laryngoscopic view of the glottis opening and vocal cords; also called external laryngeal manipulation
BURP maneuver
What is status asthmaticus?
Status asthmaticus is a severe, prolonged asthmatic attack that cannot be stopped with conventional treatment.
ECS p.940
A continuous low pitched sound which indicates the presence of mucus or fluid in the larger lower airways
Rhonchi
How does APHONIA differ from DYSPHONIA?
Aphonia = inability to speak
Dysphonia = difficulty speaking
ECS p.802
Agonal gasps are
Slow, shallow, irregular, or occasional gasping breaths; results from cerebral anoxia.
**MAY BE SEEN WHEN THE HEART HAS STOPPED BUT THE BRAIN CONTINUES TO SEND SIGNALS TO THE MUSCLES OF RESPIRATIONS** ECS p.785
What medication would you resolve wheezing in asthmatics?
ADULTS:
- Albuterol (@ 2.5mg) & Atrovent (@ 0.5mg) nebulized in SVN
- Epinephrine [consider for more severe respiratory distress] (@ 0.3mg of 1:1,000 IM)
- Solu-Medrol (@ 2mg/kg slow IV push)
- need to bronchodilate due to constriction form bronchospasm
- need to reduce bronchial edema
ECS p.941
Disadvantages of supraglottic airway
- not a definitive airway
- does not provide protection against aspiration (in fact, with an LMA, it increases risk of aspiration as stomach contents would most be directed into trachea)
- during prolonged ventilation, some wire may be insufflated into stomach because seal made at airway isn’t airtight
ECS p.870
An approximation of the extent of bronchoconstriction; used to determine whether therapy (such as with inhaled bronchodilators) is effective
Peak expiratory flow
Signs of respiratory distress/inadequate ventilation
- shallow breathing/abdominal breathing - irregular rhythm & rate - ALOC - adventitious (abnormal) breath sounds - diaphoretic/cold/cyanotic - accessory muscle recruitment/retractions - nasal flaring/pursed lips - preferential positioning (sniffing, tripod) - asymmetric/paradoxical chest wall movement - staccato speech patterns ECS p.783-784
Nasogastric (NG) tube contraindication:
- patients with severe facial injuries (particularly mid face fractures)
- skull fractures
[Although rare, the NG tube may be inserted inadvertently through the fracture and into the cranial vault]
ECS p.821
Hyperventilation can lead to
Respiratory alkalosis ECS p.782
The muscles not normally used during normal breathing, which include the sternocleidomastoid muscles of the neck and the chest and abdominal muscles
Accessory muscles
How do you measure an OPA?
Measure the distance from the corner of the patient’s mouth to the earlobe or the angle of the jaw.
ECS p.800
Irregular pattern, rate, and depth of respiration with intermittent periods of apnea; resulting from increased intracranial pressure.
Biot (ataxic) respirations
When is nasal intubation contraindicated?
Nasotracheal intubation is CONTRAINDICATED in apneic patients (in respiratory or cardiac arrest), who should receive orotracheal intubation. It is also contraindicated in patients with head trauma, possible mid face fractures or an anatomical abnormality (deviated septum, nasal polyps frequent cocaine use).
ECS p.847
Advantages of a supraglottic airway?
- provides better ventilation than a bag-mask device and adjunct airway
- does not require continual maintenance of a mask seal
- easier insertion/placement (then intubation)
- significantly less risk for trauma to soft-tissue, vocal cords, tracheal wall and teeth (then intubation)
ECS p.869
Hypoxia is
A condition ion which the tissues and cells do not receive enough oxygen. ECS p.778
What will be a remarkable symptom that differs pneumonia from COPD?
A fever would accompany pneumonia as pneumonia is inflammation of the lungs caused by bacterial, viral, or fungal infections or infections with other microorganisms.
ECS p.
What does PATENT airway refer to?
An open (& clear) airway.
ECS P.776
What adventitious lung sound produces a continuous coarse, low-pitched sound?
A) rhonchi
B) wheezing
C) stridor
D) crackles/rales
A) Rhonchi Rhonchi indicates mucus or fluid in the upper, larger lower airways. Common in patients with pulmonary edema and/or bronchitis. ECS p.787
What is lung compliance?
It is the ability to the alveoli to expand when air is drawn into the lungs during negative pressure ventilation or pushed into the lungs during positive pressure ventilation.
ECS p.804
What structures are part of the UPPER AIRWAY?
All structures that are above the glottis opening (glottis):
- nose
- mouth
- tongue
- jaw
- oral cavity
- pharynx (nasopharynx/oropharynx/laryngopharynx)
- larynx
ECS p.356/776
What structures are part of the LOWER AIRWAY?
All structures that extend from the glottis to the pulmonary capillary membrane:
- larynx (epiglottis, thyroid cartilage, glottic opening, vocal cords, cricoid cartilage)
- trachea
- bronchial tree
- lungs
- alveoli
ECS p.360/776
A 48 YOM extricated from a wrecked car; he is unconscious and has an injury to the back of his head Which is preferred?
N- Nasotracheal intubation T- Endotracheal intubation C- Cricothyrotomy
N- Nasotracheal int.
What leaf-shaped cartilaginous structure closes over the trachea during swallowing?
The epiglottis.
ECS p.777
What is the first step in airway management?
The first step is to properly position the patient (jaw thrust, head tilt-chin lift, tongue-jaw lift, recovery, etc).
ECS p.891
Tracheal breath sounds are also known as
Bronchial breath sounds.
ECS p.785
Emphysema patients are also known as
“PINK PUFFERS”
Many patients with emphysema have a barrel chest caused by chronic lung hyperinflation. These patients are often tachypneic as they attempt to maintain a normal CO2 level despite their dysfunctional lungs.
ECS p.942
Drugs that paralyze skeletal muscles; used in emergency situations to facilitate intubation; also called neuromuscular blocking agents
Paralytics
Hypoventilation can lead to
Respiratory acidosis
ECS p.782
What does an increase in peak expiration flow suggest?
An increase in peak inspiratory flow suggests that the patient is responding to treatment (such as inhaled bronchodilators).
ECS p.789
A gradually increasing rate and depth of respirations followed by a gradual decrease with intermittent periods of apnea; associated with brainstem insult.
Cheyne-Stokes respirations
A capniography waveform that has a “shark fin” characteristics is indicative of
Bronchospasm (includes asthma & COPD) and incomplete alveolar emptying.
ECS p.792-793
What does the pulse oximetry measure?
A pulse ox measures the % of hemoglobin in the atrial blood that is sutured with O2.
ECS p.787
A medication that distorts perception of sight and sound and induces a feeling of detachment from environment and self
Dissociative anesthetic
Respiration is
The exchange of oxygen and carbon dioxide in the alveoli and the tissues of the body.
ECS p.778
Cheyene-Stokes respirations are
Gradually increasing rate and depth of respiration’s followed by a gradual decrease of respiration’s with intermittent periods of apnea.
**ASSOCIATED WTH BRAINSTEM TRAUMA**
ECS p.785
The fastest way to eliminate excess H+ ions is to
Create water and CO2, which can be expelled as gases by the lungs.
ECS p.783
An 18 YOF in a coma from a drug over dose Which is preferred?
N- Nasotracheal intubation T- Endotracheal intubation C- Cricothyrotomy
N-Nasotracheal int.
__________ is severe dyspnea experienced when lying down that is relieved by a change in position, such as sitting up or standing.
A) dyspnea
B) orthopnea
C) bradypnea
How to measure an OG tube
(Position the patient’s head in a neutral or slightly flexed position). Measure the tube from the mouth to ear to xiphoid process.
ECS p.823
Kusmal respirations are
Deep, rapid respirations.
**SEEN WITH DIABETIC KETOACIDOSIS**
ECS p.785
What would likely be happening with this patient?
Choking with serve airway obstruction.
A patient grasping their throat = universal sign of choking
ECS p.804
What is the most effective method of dislodging and forcing a friend obkect out of the airway of a responsive adult or child?
Abdominal thrusts (aka Heimlich maneuver)
ECS p.804
CPAP contraindications:
- pt is unresponsive, unable to follow renal commands and/or unable to sit up
- respiratory arrest or agonal respirations
- pt is unable to speak and/or protect her own airway
- hypoventilation
- hypotension
- signs & symptoms of pneumothorax or chest trauma
- closed head injury or facial trauma
- cardio genie shock
- tracheostomy
- active GI bleeding, nausea, vomiting and/or recent GI surgery
- inability to fit the CPAP mask or pt is unable to tolerate the mask
Normal PaCO2 is
35 to 45 mm Hg
ECS p.790
A surgical procedure in which the larynx is removed
Laryngectomy
A 65- year old man in cardiac arrest Which is preferred?
N- Nasotracheal intubation T- Endotracheal intubation C- Cricothyrotomy
T- Endotracheal Intubation
When is nasal intubation indicated?
Nasal intubation is indicated for patients who are breathing spontaneously but require definitive airway management to prevent further deterioration of their condition.
Reeponsive patients and patients with an ALOC and intact gag reflex who ar win respiratory failure because of conditions such as COPD, asthma or pulmonary edema are excellent candidates for nasotracheal intubation.
ECS p.847
What is the OPA designed to hold back?
An OPA is designed to hold the tongue away from the posterior pharyngeal wall, and its use makes it much easier to ventilate patients with a bag-valve device.
ECS p.799
What adventitious lung sound produces a continuous coarse, low-pitched sound?
A) rhonchi
B) wheezing
C) stridor
D) crackles/rales
A) Rhonchi
Rhonchi indicates mucus or fluid in the upper, larger lower airways. Common in patients with pulmonary edema and/or bronchitis.
ECS p.787
How do you measure a nasopharyngeal (nasal) airway?
Measure the distance from the corner of the patient’s nostril to the earlobe.
ECS p.800
Abdominal thrusts performed to relieve a foreign body airway obstruction
Abd thrust maneuver
What are tactile fremitus?
Chest vibrations as the patient breathes are due to larger-airway secretions that are usually easy to feel and to hear.
ECS p.925
What is normal SpO2 on room air?
A normally perfumed person, on room air, should have an SpO2 level of greater that 95%. ECS p.787
What two tools can be used to help visualize the airway and remove a foreign body?
Early signs of hypoxia include
- restlessness - irritability - apprehension - tachycardia - anxiety ECS p.779
In the context of the airway the resultant orifice of a tracheostomy that connects the trachea to the outside air; located in the midline of the anterior part of the neck
Stoma
Normal respiration rate
12-20 breaths/min ECS p.783
Normal PaCO2 is
35 to 45 mm Hg ECS p.790
Intrapulmonary shunting is
When blood enters the lungs from the right side of the heart and bypasses the nonfunctional/damaged alveoli, and returns to the left side of the heart in an unoxygenated state. ECS p.781
A 28 YOF with complete airway obstruction from laryngeal edema Which is preferred? N- Nasotracheal intubation T- Endotracheal intubation C- Cricothyrotomy
C- Cricothyrotomy
Average normal resting minute volume is
6 L/min ECS p.779
How to properly measure the NG tube:
Measure the tube from nose to ear to xiphoid process.
ECS p.821
Late signs of hypoxia include
- changes in mental status - weak (thready) pulse - cyanosis - dyspnea ECS p.779
Apneustic respirations are
Prolonged, gasping inhalation followed by extremely short, ineffective exhalation. **ASSOCIATED WITH BRAINSTEM TRAUAM** ECS p.785
A capnogaphy waveform like below would indicate:
A) Adequae ventilation
B) Hypoventialtion
C) Hyperventilation
C) Hyperventilation
ET tube size for adult female & male
Adult female: 7.0- to 8.0-mm tube
Adult male: 7.5- to 8.5-mm tube
What are the two types of hemoglobin normally found in healthy individuals?
Oxyhemoglobin (HBO2), hemoglobin that is occupied by oxygen, and reduced hemoglobin, the hemoglobin after the oxygen has been released. ECS p.789
A 52 YOF who was given succinylcholine ( a paralytic) prior to an intubation attempt; the attempt failed and afterward it became impossible to maintain her airway by manual methods Which is preferred? N- Nasotracheal intubation T- Endotracheal intubation C- Cricothyrotomy
C-Cricothyrotomy Intub.
Major difference between NG and OG tube
Prolonged gasping inspirations followed by extremely short, ineffective expirations; associated with brainstem insult
Apneustic respirations
What is Fentanyl and it’s affect?
Fentanyl is an opioid (type of narcotic with potent analgesic and sedative properties). Fentanyl is 70 to 150 times MORE potent then morphine. It has a rapid onset & relatvively short duration of action.
Opiods cause profound respiratory and CNS depression and produces severe hypotension and bradycardia, especially in patients who are in a hemodynamically unstable condition.
Negatvie effects can be reversed with naloxone (Narcan).
ECS p.862
How do you describe ASYMMETRIC chest wall movement?
One side of the chest moves less than the other, indicative that airflow into one lung is decreased.
ECS p.784
What is capnograpahy?
Capnography provides quantitative, real-time information regarding the patient’s exhaled CO2 levels - via waveform and/or digital numeric representation.
ECS p.791
What is normal SpO2 on room air?
A normally perfumed person, on room air, should have an SpO2 level of greater that 95%. ECS p.787
Cor pulmonale is
Insertion of an endotracheal tube into the trachea through the mouth
Orotracheal intubation
An automatic reaction when something touches an area deep in the oral cavity that helps protect the lower airway from aspiration
Gag Reflex
Intubation visual landmarks:
After you have identified the EPIGLOTTIS, place tip of curved blade in vallecular space. Gently lift until GLOTIC OPENING comes into full view. You should see the VOCAL CORDS and ARYTENOID CARTILAGE.
ECS p.837
A capnogaphy waveform like below would indicate:
A) Adequae ventilation
B) Hypoventialtion
C) Hyperventilation
B) Hypoventilation
Ventilation is
The physical act of moving air into and out of the lungs. ECS p.778
A device that measures oxygen saturation level
Pulse oximeter
Gastric decompression involves
CPAP indications:
For conscious/responsive patients experiencing respitory distress due to:
- acute pulmonary edema
- acute bronchopasm
- obstructive lung disease
ECS p.818
Slow shallow irregular respirations or occasional gasping breaths that result from cerebral anoxia
Agonal gasps
Biot (ataxic) respirations are
Irregular pattern, rate and depth of breathing with intermittent periods of apnea. **RESULTS FROM INCREASED ICP** ECS P.785
Forcing of air into the lungs provides
Positive pressure ventilation
__________ is difficult or labored breathing.
A) dyspnea
B) orthopnea
C) bradypnea
A) Dyspnea
What is the most common airway obstruction in an unresponsive patient?
The tongue. ECS p.779
What adventitious lung sound is a high-pitched sound that may be heard on inspiration, expiration, or both? A) rhonchi B) wheezing C) stridor D) crackles/rales
B) Wheezing Wheezing is a continuous sounds as air flows through a constricted lower airways, such as with asthma or bronchiolitis. ECS p.787
What is a V/Q mismatch?
V/Q mismatch is a failure to match ventilation and perfusion, and contributes to most abnormalities in oxygen and CO2 exchange. ECS p.779
What adventitious lung sound produces a loud-high pitched sound, typically during the inspiration phase? A) rhonchi B) wheezing C) stridor D) crackles/rales
C) Stridor Strider often results from foreign body aspiration, disease, or trauma within or immediately above the glottic opening (ie. an upper airway obstruction). ECS p.787
Chronic Bronchitis patients are known as
“BLUE BLOATERS”
The hallmark of this disease is excessive mucus production in the bronchial tree which is nearly always accompanied by a chronic/recurrent productive cough.
A typical patient with chronic bronchitis is almost invariably a heavy cigarette smoker. They are usually overweight and congested and sometimes have a blue complexion as their blood levels gases tend to be abnormal with eleveated PaCO2 (hypercapnia) and decreased PaO2 (hypoxemia).
ECS p.941-942
Hypoxemia is
Low level of oxygen in the arterial blood. ECS p.783
The continued alveolar uptake of oxygen even when the PT is apneic; can be facilitated by administering O2 via NC during intubation
Apneic oxygenation
____________ is when systolic blood pressure drops more than 10 mmHg during inhalation A) pulse pressure B) pulsus alterens C) pulsus paradoxus D) hypotension
C) Pulsus paradoxus This is generally seen in patients with decompensating COPD, servers pericardial tampon are, or other conditions that cause an increase in intrathoracic pressure. ECS p.784
A capnography waveform like below would indicate:
A) Adequate ventilation
B) Hypoventialtion
C) Hyperventilation
A) Adequate ventilation
What adventitious lung sound is a discontinuous popping or crackling sound upon inspiration? A) rhonchi B) wheezing C) stridor D) crackles/rales
D) Crackles/rales Crackles (formerly known as rales) occur when airflow causes mucus or fluids in the airways to move in the smaller lower airways. Crackles may also be heard when collapsed airways or alveoli pop open; can be fine or coarse. Common in patients with COPD and/or reduced lung volumes. ECS p.787
Normal blood pH is
7.35 to 7.45 ECS p.790
What are two anticholinergic bronchodilators?
1) Albuterol @ 2.5mg in SVN => more effective in dilation of SMALLER peripheral airways
2) Atrovent (Ipratropium) @ 0.5mg in SVN => more effective in dilation of LARGER central airways
INDICATIONS:
- Bronchospams secondary to Asthma, COPD, toxic inhalation’s & CHF [if pt has wheezing]
Hypoventilation (slow and/or shallow breathing) causes
- decrease in minute volume - decrease in C02 elimination - increase in PaCO2 (=HYPERCAPNIA) ECS p.780
A 58 YOM with pulmonary edema, who has been taking warfarin (coumadin; an anticoagulant drug) ever since his heart attack last year Which is preferred? N- Nasotracheal intubation T- Endotracheal intubation C- Cricothyrotomy
T-Endotracheal Intub.
What is a contraindication for an oropharyngeal (oro) airway?
A 26 YOM MVC victim with clear fluid draining from his nose and left ear Which is preferred? N- Nasotracheal intubation T- Endotracheal intubation C- Cricothyrotomy
T- Endotracheal int.
Positional dyspnea
Orthopnea
_______________ is a beat-to-beat difference in the strength of the pulse and may be a sign of severe ventricular failure.
A) pulsus paradoxus
B) pulse pressure
C) pulsus alternans
D) hypertension differentiation
C) Pulsus alternans
It is believed the beat-to-beat changes in pulse strength are a result of a decrease in the number of myocardial cells contracting during alternate beats, resulting in decreased myocardial contractility.
ECS p.967
An absence of oxygen
Anoxia
What structure marks where the upper airways ends and the lower airways begins?
The larynx. ECS p.776
A 6 YOM who choked on a piece of meat Which is preferred? N- Nasotracheal intubation T- Endotracheal intubation C- Cricothyrotomy
T-Endotracheal intub.
Oxygenation is
The process of loading oxygen molecules onto the hemoglobin molecules in the bloodstream. ECS p.778
What is the normal inspiratory/expiration (I/E) ratio?
The normal I/E ratio is 1:2 (expiration is twice as long as inspiration). ECS p.786
The gag reflex is
A spastic pharyngeal and esophageal reflex caused by stimulation the posterior pharynx (to prevent foreign bodies from entering the trachea). ECS p.783
What is as hypoxic drive?
It is a state in whic a person’s stimulus to breathe comes from a decrease in PaO2 rather than from the normal stimulus (an increase in PaCO2).
ECS p.943
